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PTP 546 Module 12: Gastrointestinal Pharmacology

PTP 546 Module 12: Gastrointestinal Pharmacology. Jayne Hansche Lobert, MS, RN, ACNS-BC, NP. Gastrointestinal Pharmacology. Drugs to treat gastric acidity and secretion Antacids Ex: Aluminum Hydroxide (Maalox) Ex: Calcium Carbonate(Mylanta) Histamine (H2) Receptor Blockers

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PTP 546 Module 12: Gastrointestinal Pharmacology

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  1. PTP 546Module 12: Gastrointestinal Pharmacology Jayne Hansche Lobert, MS, RN, ACNS-BC, NP Lobert

  2. Gastrointestinal Pharmacology • Drugs to treat gastric acidity and secretion • Antacids • Ex: Aluminum Hydroxide (Maalox) • Ex: Calcium Carbonate(Mylanta) • Histamine (H2) Receptor Blockers • Ex: Famotidine (Pepcid) • Ex: Ranitidine (Zantac) • Proton Pump Inhibitors • Ex: Omeprazole (Prilosec) • Ex: Esomeprazole (Nexium) Lobert

  3. Gastrointestinal Pharmacology • Antacids • Ex: Aluminum Hydroxide (Amphogel; Maalox) • Ex: Magnesium Hydroxide (Riopan) • Ex: Calcium Carbonate (Tums, Mylanta) • Ex: Sodium Bicarbonate (Alka-Seltzer, Baking Soda) • Action: med combines with hydrochloric acid (HCL) to form a salt and water neutralization of hydrochloric acid alters gastric pH • Therapeutic Effect: treatment of gi discomfort, transient dyspepsia, indigestion & heartburn by the neutralization of gastric acids • Side Effects: constipation with aluminum based antacids, diarrhea with magnesium based antacids; will alter metabolism of drugs requiring acidic environment for absorption Lobert

  4. Gastrointestinal Pharmacology • Histamine (H2) Receptor Blockers • Ex: Famotidine (Pepcid) • Ex: Ranitidine (Zantac) • Action: block the histamine activated release of gastric acids from the gastric parietal cells  reduction of acid secretions • Therapeutic Effect: control gastric acid secretion associated with dyspepsia, gastroesophageal reflux disease (GERD), peptic ulcer disease • Side Effects: rarely nausea, headache, dizziness, confusion in older adults Lobert

  5. Gastrointestinal Pharmacology • Proton Pump Inhibitors (PPI) • Ex: Omeprazole (Prilosec) • Ex: Esomeprazole (Nexium) • Action: Inhibition of the enzyme that is responsible for gastric acid secretion from the parietal cells; 90% reduction in the “acid pump” • Therapeutic Effect: reduction of gi symptoms associated GERD and peptic ulcers • Side Effects: rebound hyperacidity Lobert

  6. Gastrointestinal Pharmacology • Pharmacologic Treatment of Peptic Ulcers • Antacids • Aluminum Hydroxide (Maalox) • H2 Blockers • Ranitidine (Zantac) • PPI’s • Omeprazole (Prilosec) • Antibacterials • Clarithromycin (Biaxin), • Amoxicillin (Amoxil) • Metronidazole (Flagyl) • Tetracycline (Achromycin) Lobert

  7. Gastrointestinal Pharmacology • Antidiarrheals • Adsorbents • Ex: Bismuth Salts (Pepto Bismol, Kaopectate) • Opioid Derivatives • Ex: Diphenoxylate with atropine (Lomotil) • Ex: Loperamide (Imodium) Lobert

  8. Gastrointestinal Pharmacology • Opioid Derivatives • Ex: Diphenoxylate with Atropine (Lomotil) • Ex: Loperamide (Imodium) • Action: slows peristalsis allowing for more water reabsorption more solid stools • Therapeutic Effect: treatment of chronic diarrhea, moderate to severe diarrhea • Note: there is no analgesic effect • Side Effects: dizziness, drowsiness Lobert

  9. Gastrointestinal Pharmacology • Adsorbents • Ex: Bismuth Salts (Pepto Bismol, Kaopectate) • Action: binds toxins that contribute to diarrhea, increases absorption of fluids and electrolytes • Therapeutic Effect: relief of mild diarrhea, prevention of “travelers diarrhea” • Side Effects: constipation, stool impaction Lobert

  10. Gastrointestinal Pharmacology • Pharmacologic Treatment of Inflammatory Bowel Disease (IBD) • Antidiarrheals • Corticosteroids • Antiinfectives • Antiinflammatories • Mesalamine (Asacol, Pentasa) • Immunosuppressants • Azathiprine (Imuran) • Biologic Therapies • Infliximab (Remicade) • Adalimumab (Humira) Lobert

  11. Gastrointestinal Pharmacology • Laxative and Cathartics • Bulk Forming Ex: Psyllium Mucilloid (Metamucil) • Action: absorb water adding to size of fecal mass • Osmotic Ex: Polyethylene Glycol (Miralax) • Action: creates osmotic pull of fluids into gi tract • Stimulant Ex: Bisacodyl (Dulcolax) • Action: irritates bowel mucosa  stimulates bm • Stool Softener Ex: Docusate (Colace) • Action: causes water and fat to be absorbed in stool • Herbal Ex: Senna (Senokot) • Action: irritates the bowel and increases peristalsis Lobert

  12. Gastrointestinal Pharmacology • Laxatives and Cathartics • Pharmacologic Classes • Bulk Forming, Osmotics, Stimulants, Softeners, Herbals • Therapeutic Uses: prevention and treatment of constipation, prep for gastrointestinal testing (colonoscopies, etc) or gastrointestinal surgeries • Side Effects: abdominal cramping, diarrhea, fluid and electrolyte loss, nausea Lobert

  13. Gastrointestinal Pharmacology • Pharmacologic Treatment for Nausea and Vomiting: Antiemetics • Serotonin Antagonists • Ex: Ondansetron (Zofran) • Antihistamines • Ex: Menhydrinate (Dramamine), Meclizine (Antivert) • Anticholinergics • Ex: Scopolamine (Transderm Scop) Lobert

  14. Gastrointestinal Pharmacology • Antiemetics • Classes: serotonin antagonists, antihistamines, anticholinergics • Action: depress the CNS chemoreceptor zone through a variety of mechanisms • Therapeutic Effect: treatment of chemotherapeutic drug side effects, prevention of nausea, prevention of motion sickness/nausea, Lobert

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